Osteoarthritis is a chronic progressive disease where there is degeneration & loss of articular cartilage that occurs together with new bone formation at the joint surfaces and margins, that causes pain and deformity.

Acute pain can often be managed without opioids; 3 days or less & not greater than 7 days will often be sufficient for opiod prescription

Recommended in patients with moderate-severe OA pain who have failed to respond to, or unable to tolerate pharmacologic & nonpharmacologic treatments & are unwilling or unqualified to undergo total joint arthroplasty

Not recommended for patients with hand OA

Non-narcotic opioids may be combined with Paracetamol to provide similar analgesic effect

If used for acute pain, the lowest possible effective dose & exact quantity of immediate-release opioids should be prescribed

Narcotic opioids may be an option in managing patients with inadequate response or contraindications to other analgesics

May cause CNS depression or addiction & has lack of disease-modifying properties

Drugs for Neuropathic Pain

Eg Duloxetine

Studies have shown that Duloxetine significantly reduced pain & improved function in patients suffering from pain due to knee OA

Conditionally recommended for patients with knee OA who had treatment failure after initial therapy, & for symptomatic knee OA patients who had inadequate clinical response after nonpharmacologic & pharmacologic treatment who are unwilling or not qualified to undergo total joint arthroplasty

Topical Analgesics

Used as an adjunctive treatment in patients with knee or hand OA who have mild-moderate pain who do not respond to Paracetamol & do not want to use systemic therapy

Land & aquatic exercises are both recommended for patients with symptomatic knee & hip OA

The choice between land & aquatic exercises depend on the patient’s preference & ability

Aquatic exercises are preferred for patients with hip OA because of lesser stress to the joints due to buoyancy

Tai chi is recommended for patients with knee OA

Several studies have shown pain improvement in patients practicing tai chi as compared to those with out exercise

Weight Reduction

Patients with symptomatic OA, esp of the knee & hip, should be encouraged to lose minimum of 5% of their body weight & maintain their weight at a lower level with an appropriate program of dietary modification & exercise

The use of trabecular bone score (TBS) may be helpful in evaluating osteoporosis in ankylosing spondylitis (AS), as it is associated with the erythrocyte sedimentation rate (ESR) and severity of sacroiliitis in young male patients with AS, suggests a recent study.